The Clinical Impact of Enhanced Surface Technology on Post-Operative Opioid Consumption in Patients Undergoing Anterior Lumbar Interbody Fusion — The International Society for the Study of the Lumbar Spine
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The Clinical Impact of Enhanced Surface Technology on Post-Operative Opioid Consumption in Patients Undergoing Anterior Lumbar Interbody Fusion (#1092)

Paul Slosar 1 , Steven McAnany 2 , David DeWitt 3
  1. SpineCare Medical Group, Daly City, CA, United States
  2. University of Wisconsin, Madison, WI, USA
  3. NeuroSpine Center of Wisconsin, Appleton, WI, USA

Introduction:  Interbody fusion devices with nano-surface topography technology have been shown to stimulate a local cellular response promoting osteogenic differentiation and angiogenic growth factors, which are essential to interbody fusion [1,2].The nano-surface topography has also been shown to decrease pro-inflammatory interleukins and increase anti-inflammatory cytokines, when compared to alternatives [3]. This change in inflammatory cytokine response to a nano-surface interbody cage might reduce postoperative pain and opioid consumption.There have been several studies that have examined the effect of multimodal pain regimens on reducing pain and opioid consumption following spine surgery. However, we are unaware of any studies that have evaluated the effect of specific spinal fusion implants on postoperative pain and opioid use.

Methods: This is a retrospective cohort study of consecutively treated patients undergoing ALIF. Patients received either the standard control surface technology (Endoskeleton™) or the investigational nano-enhanced surface technology (NanoLOCK™). Patients were assessed at three post-operative follow-up visits for ongoing presence or absence of opioid use and for total daily morphine milligram equivalents (MME) consumption. Surgical demographic variables were recorded. A logistic multivariate regression as performed to identify factors predictive of opioid use at final follow-up. Two-way repeated measures ANOVA was used to compare the groups at each time point.

Results: 120 patients were included in the analysis, with 61 patients receiving the standard control cage surface and 59 receiving the experimental surface technology. The control group had a higher rate of smokers and pre-operative opioid use. Regression analysis confirmed that smoking status and cage surface type were predictive of opioid use at final follow-up. Two-way repeated measures ANOVA demonstrated that the opioid usage rate was significantly lower in the experimental cage group at all post-operative time points. Patients in the control cohort were found to have a 4.5 times greater likelihood of using opioids at the three-month follow-up appointment. 

Discussion:Studies have shown that osteoblasts and stem cell interact with specifically engineered surface features on a nano-surface implant initiating an endogenous cellular and biochemical response. Effects include increased production of TGF-B1 and BMPs 2, 4, and 7 with up-regulation of osteoblast differentiation and reduction of Interleukins 1B, 6, and 8 to minimize pathologic inflammatory responses [1-5]. It is the modulation of the pro-inflammatory cytokines which may result in decreased pain in the investigational cohort as well as the potential for more rapid osseointegration of the implant. By reducing the negative inflammatory effects of spinal fusion and promoting an osteogenic tissue response in patients undergoing an ALIF procedure with a nano-surface implant, a reduction in opioid usage and daily MME consumption may be achieved, compared to standard implants.

 

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